Accela Staff is an equal opportunity employer. Applicants will be considered regardless of race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status. Equal access to the hiring process, services, and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the HR representative.

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1

Full Name* This field is required

First Name

Last Name

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2

Position applying for* This field is required

Personal Support Worker

Companion

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3

Do you have a Personal Support Worker (PSW) Certificate from an educational institution approved by the Ministry of Training, Colleges and Universities or the National Association of Career Colleges (NACC)?* This field is required

YESNO

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4

Highest level of education completed?* This field is required

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5

How many days are you available to work?* This field is requiredFrom Monday to Sunday

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6

Is your current Vulnerable Sector Screening (VSS) beyond 8 months?* This field is required

YESNO

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7

You need to apply for a new Vulnerable Sector Screening (VSS). Refer to your Regional Police Service website(s) for more information.

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8

Do you have a personal record of the immunizations (vaccines) you have had in your lifetime?* This field is required

YESNO

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9

If you do not have a card or booklet with your immunizations, contact your doctor, nurse or local public health office.

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10

Is your tuberculin skin test (also called a Mantoux tuberculin test) beyond 12 months?* This field is required

YES

NO

DOES NOT APPLY

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11

Contact your doctor or local public health office to receive a tuberculin skin test.

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12

Is your chest X-ray beyond 24 months?* This field is required

YESNO

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13

Contact your doctor or local public health office to udergo chest X-ray.

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14

Do you have a valid Standard First Aid & CPR Certificate Health Care Provider (HCP or Level C) level?* This field is required

Are you available to work?* This field is requiredSelect all that apply

Day

Evening

Night

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17

Salary desired (hourly)* This field is required

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18

Date you can start* This field is required

Date

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Day

Year

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19

Do you own a car?* This field is required

Yes

No

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20

Are you fluent in a foreign language?* This field is required

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No

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21

What language(s)?* This field is required

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22

Have you ever been convicted of a crime in a court of law?* This field is required

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No

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23

Please explain* This field is required

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24

How did you hear about this position?* This field is required

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25

Address* This field is required

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26

Telephone number* This field is required

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27

E-mail* This field is required

example@example.com

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28

Cover Letter

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Resume* This field is required

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30

By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed by Accela Staff Inc., my employment may be terminated at any time. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by Accela Staff Inc.

Accela Staff Inc. may conduct an employment verification, education verification, driver’s license check, criminal background check, reference check, and/or other inquiries regarding my background and employment history, including information as to my personal character, general reputation, job performance, and other qualities pertinent to my prospective service. I hereby consent and authorize Accela Staff Inc. and/or their designated agents to make such inquires, and I authorize without reservation, the release of such information to their client and/or their designated agents, and release Accela Staff Inc. and the provider of such information from any and all liability for damages arising from the investigation and disclosure of the requested information. I will allow a photocopy/fax/email copy of this authorization to be as valid as the original.

In consideration of my employment, I agree to conform to the Accela Staff's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at Accela Staff's decision.